Medicina, Volume 46, Issue 7 (July 2010) – 10 articles

The aim of our study was to determine the prevalence of Pseudomonas aeruginosa bacteremia, risk factors, and outcome of patients treated at the Hospital of Kaunas University of Medicine.
Material and methods. All hospitalized patients with blood culture positive for Pseudomonas aeruginosa during the 5-year period were included. A retrospective data analysis was performed to evaluate patients’ risk factors and mortality caused by P. aeruginosa bacteremia.
Results. A total of 47 (58.8%) bacteremia episodes occurred in an intensive care unit (ICU). A primary source of bacteremia was identified in 50 (62.5%) episodes. Overall mortality rate was 58.8%. Univariate risk factors analysis showed the factors, which significantly increased the risk of death: mechanical ventilation (13.67 times, P<0.001), patient hospitalization in the ICU (8.51 times, P<0.001), acute respiratory failure (8.44 times, P<0.001), infection site in the respiratory tract (4.93 times, P=0.003), and central vein catheter (4.44 times, P=0.002). Timely and appropriate treatment and surgery were significant protective factors for 30-day mortality (11.1 and 5.26 times, respectively; P=0.001). Meropenem-resistant Pseudomonas aeruginosa strains caused bacteremia more frequently in patients older than 65 years than meropenem-sensitive strains (57.9%, n=11). All 19 patients with meropenem-resistant Pseudomonas aeruginosa bacteremia received inappropriate empirical antibiotic therapy.
Conclusions. Treatment at the intensive care unit, mechanical ventilation, acute respiratory failure, source of infection in respiratory tract, and central vein catheter are the major risk factors associated with an increased mortality rate in patients with Pseudomonas aeruginosa bacteremia. The patients older than 65 years are at increased risk for bacteremia caused by carbapenemresistant Pseudomonas aeruginosa strains. Carbapenems are not antibiotics of the choice of treatment for Pseudomonas aeruginosa bacteremia at the Hospital of Kaunas University of Medicine. Full article

The objective of the study was to analyze associations among quality of sleep, profile of the studies, and lifestyle factors among the students of three different study profiles (medicine, economics, and law).
Material and methods. A total of 405 randomly selected students from the first and fourth years of studies from 4 different universities in Lithuania answered the standardized questionnaires consisting of two parts: 1) the Pittsburgh Sleep Quality Index (PSQI) for subjective evaluation of sleep quality; 2) the questionnaire about sleep and lifestyle habits and impact of poor sleep on the quality of life developed by the researchers.
Results. More than half (59.4%) of the students scored higher than 5 on the PSQI, which allowed suspecting sleep disorders. A significant difference in the frequency of poor sleepers was found regarding the profile of studies (P<0.05) showing the highest frequency of sleep disturbances among medical students. There was a significant correlation between quality of sleep and subjective evaluation of quality of life (P<0.01). Medical students experienced the highest impact of poor sleep on the quality of life (P=0.008). Students studying before going to sleep, spending more time studying, and having less leisure time had worse quality of sleep (P<0.01). A significant difference was found among three profiles of studies regarding the anxiety about studies (P<0.0005) and subjective estimation of success in studies (χ²=27.9, P<0.0005), showing the highest anxiety and worst satisfaction among students of medicine.
Conclusions. The incidence of sleep problems is high among students in Lithuania, reaching 59.4%. Medical students have worse quality of sleep and worse impact of poor sleep on the quality of life compared to students of law and economics. A significant difference was found between medical students and their peers in other profiles of studies regarding their attitudes and habits related to studies: medical students spent more time for studying, were more anxious about studies and less satisfied with the results, studied more often before going to sleep. Full article

Intussusception is a pediatric condition that rarely presents in adults. Colonic lipomas 4 cm and more in diameter can cause colonic intussusception leading to emergency operation. Surgical resection of the involved segment must be the procedure of choice. We report a case of colonic intussusception caused by colonic lipoma in an adult. The patient underwent operation, and histopathological examination of the specimen confirmed the diagnosis of colonic submucosal lipoma. Full article

The aim of this study was to evaluate changes in extraocular muscle thickness and to assess its correlation with the degree of proptosis in patients with Graves’ ophthalmopathy (GO).
Material and methods. A total of 242 patients (207 females and 35 males) with Graves’ ophthalmopathy were enrolled into the study (GO group). Their mean age was 53.83±14.49 years. In addition, we examined an age-matched (53.51±12.79 years) control group of 40 healthy persons. All the participants underwent ophthalmological examination, including eye protrusion measurement and ultrasonographic evaluation of extraocular muscles thickness.
Results. The mean exophthalmos in the GO and control groups was 17.84±2.79 mm and 16.0±1.58 mm, respectively. The enlargement of inferior rectus muscle was recorded in 92.1% of patients, lateral rectus muscle in 81.2%, and medial rectus muscle in 50.8% (P<0.001). A significant correlation between exophthalmos and muscle thickness sum was found in the GO group (Spearman correlation coefficient, 0.515; P<0.0001).
Conclusions. Graves’ ophthalmopathy is more frequent in medium-aged women than men. A significant enlargement of inferior, lateral, and medial straight muscles was noticed in the GO group. With increasing proptosis, the sum of the muscle thickness was increasing, and exophthalmos moderately correlated with muscle thickness sum. Full article

Background and objective. Hepatic hypoperfusion is regarded as an important factor in the pathophysiology of perioperative liver injury. Although thoracic epidural anesthesia is a widely used technique, limited data are available about the effects on hepatic blood flow with blockade restricted to thoracic segments in humans. The main objective of the present study was to investigate the effects of thoracic epidural anesthesia on hepatic blood flow under general anesthesia in humans.
Material and methods. In 40 patients under general anesthesia, we assessed hepatic blood flow using plasma disappearance rate of indocyanine green (PDR_ICG) as a simple noninvasive method before and after induction of thoracic epidural anesthesia. The epidural catheter was inserted at the Th_7/8 or Th_8/9, and 1% lidocaine at a mean (range) dose of 8 (6–10) mL was injected. Ephedrine bolus was given to patients who demonstrated a decrease in mean arterial blood pressure below 60 mm Hg after induction of thoracic epidural anesthesia (TEA-E group). Other patients did not receive any catecholamines during the study period (TEA group). Ten patients who did not undergo TEA served as controls (control group).
Results. In 7 patients, administration of ephedrine was necessary to avoid a decrease in mean arterial blood pressure below 60 mm Hg. Thus, the TEA-E group consisted of 7 patients and TEA group of 33. In the TEA group, thoracic epidural anesthesia was associated with a mean 2.3% min^–1 decrease in PDR_ICG (P<0.05). In the TEA-E group, all seven patients showed a 2.2% min–1decrease in PDRICG (P<0.05). Patients in the control group showed a mean 1.1% min–1 increase in PDRICG (P<0.05). In contrast to hepatic blood flow, cardiac output was not affected by thoracic epidural anesthesia.
Conclusions. In humans, thoracic epidural anesthesia is associated with a decrease in hepatic blood flow. Thoracic epidural anesthesia combined with ephedrine bolus was found to result in further decrease in hepatic blood flow. Full article

Background. The aim of our study was to evaluate the incidence of early postoperative cognitive decline (POCD) and determine perioperative risk factors as well as the impact of asymptomatic cerebral vascular lesion on the development of neurocognitive complications.
Materials and methods. A total of 127 consecutive adult patients undergoing on-pump coronary artery bypass grafting were studied. Neuropsychological testing was performed the day before surgery and 7–9 days after operation. Stepwise logistic regression analysis determined independent predictors of POCD.
Results. The incidence of postoperative cognitive decline was 46% (n=59). Patients in the POCD group were older (P=0.04) and had an increased prevalence of asymptomatic carotid artery stenosis (P=0.0001). POCD was associated with longer time in surgery (P=0.018), inotropic support intraoperativelly (P=0.02) and during postoperative period (P=0.008). Patients in the POCD group had an increased incidence of postoperative bleeding (P=0.037), delirium (P=0.016) and stayed in hospital for a longer period (P=0.007). Age of more than 65 years (OR, 2.7), asymptomatic carotid artery stenosis of more than 50% (OR, 26.89), duration of surgery of more than 4 hours (OR, 4.08), postoperative mechanical ventilation of more than 6 hours (OR, 3.33), and stay in an intensive care unit for more than 3 days (OR, 3.38) were significant independent predictors of cognitive decline.
Conclusions. Increased age, preoperative prevalence of craniocervical atherosclerotic lesions, longer time in surgery, longer stay in an intensive care unit and mechanical ventilation time were found to be the risk factors for developing postoperative cognitive decline. Full article

It remains unclear whether the Helicobacter pylori eradication may cause or provoke gastroesophageal reflux disease. Therefore, we aimed to elucidate the role of H. pylori eradication and other factors in the development of erosive esophagitis in patients with duodenal ulcer.
Materials and methods. We enrolled 183 H. pylori-positive duodenal ulcer patients without erosive esophagitis. Final endoscopy was performed 12 months later or in case if ulcer relapse was suspected. H. pylori was diagnosed by the urease test and histology if the results of at least one of the tests were positive. A total of 142 patients were assigned to the eradication treatment. The control group included 41 volunteers – 20-mg omeprazole b.i.d. for 4 weeks was administered.
Results. A total of 150 patients completed the study. Of the 119 patients, 70 (58.8%) were cured from H. pylori, and in 49 (41.2%) of patients, treatment of H. pylori was unsuccessful. All 31 controls remained H. pylori-positive. At the final endoscopy, erosive esophagitis was found in 19 (12.7%) patients. Erosive esophagitis developed in 8 (11.4%) successfully eradicated patients, in 9 (18.4%) unsuccessfully treated patients, and in 2 (6.5%) controls (P>0.05 comparing the groups). Multivariate logistic regression analysis revealed 3 factors at baseline, which were significant (P<0.05) in predicting the occurrence of erosive esophagitis: age more than 43 years (OR, 4.96; 95% CI, 1.47–16.71), nonerosive gastroesophageal reflux disease (OR, 3.96; 95% CI, 1.34–11.68), and smoking (OR, 3.17; 95% CI, 1.01–9.17).
Conclusions. H. pylori eradication did not influence the incidence of erosive esophagitis in patients with duodenal ulcer during a one-year follow-up period. Pre-existing nonerosive gastroesophageal reflux disease, smoking, and older age are important predictors of de novo development of erosive esophagitis. Full article

A fundamental question in the theory of psychobiological adaptation and specifically of sports training is the problem of how adaptation to sports performance demands occurs as a consequence of systematic exercise. In this position paper, we review some results of our previous and current research conducted on several different levels of exercise-induced effects. Based on these results, we contend that the control of psychobiological systems during exercise is constraints based. Constraints direct the flow of behavioral changes on a rugged metastable landscape. Such adaptive behavior is soft-assembled, consisting of context-sensitive cooperative configurations of system components that dwell on different time scales. Full article

Sergančiųjų šlapimo nelaikymu, metams bėgant, daugėja. Moterys ir vyrai iki 85 metų serga santykiu 2:1, vėliau sergamumas būna vienodas – 1:1. Šlapimo nelaikymas – tai liga, lemianti fizinę žmonių veiklą, emocinę pusiausvyrą, darbingumą bei socialinį bendravimą. Nelaikantys šlapimo žmonės turi psichologinių sunkumų, nevisavertiškumo jausmą, nerimą dėl ateities, diskomfortą dėl galimo blogo šlapimo kvapo. Dalis pacientų vengia viešai kalbėti apie esamą problemą, nedrįsta pasakoti gydytojui apie savo negalavimus. Literatūros duomenimis, vyrauja keletas šlapimo nelaikymo gydymo būdų, kurie taikomi klinikinėje praktikoje. Apibendrinus ir išanalizavus įvairias gydymo metodikas, nustatyta, kad šlapimo nelaikymo pradiniame etape rekomenduojami konservatyvūs gydymo būdai. Vėliau, nesant teigiamo poveikio, taikomi chirurginiai gydymo metodai. Full article

In this article, the most recent literature data regarding the diagnosis of sarcoidosis have been reviewed. The diagnosis of sarcoidosis can be reliably established when there is a compatible clinical/radiological picture together with pathologic evidence of noncaseating epithelioid cell granulomas. Pathologic specimens can be obtained by conventional bronchoscopy with endobronchial, transbronchial lung biopsy, bronchoalveolar lavage, and recently introduced endoscopic ultrasound techniques (endoscopic ultrasound-guided fine-needle aspiration, EUS-FNA, and endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA) or surgical procedures such as thoracotomy, thoracoscopy, and mediastinoscopy. The place and value of EBUS-TBNA or EUS-FNA in diagnosis of sarcoidosis are discussed. Full article